Provider Demographics
NPI:1679846836
Name:SOOLMAN, JOANNE LEVY (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:LEVY
Last Name:SOOLMAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WASHINGTON STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5925
Mailing Address - Country:US
Mailing Address - Phone:781-237-0470
Mailing Address - Fax:
Practice Address - Street 1:555 WASHINGTON STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5925
Practice Address - Country:US
Practice Address - Phone:781-237-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered